Cauterization devices, methods, and systems

ABSTRACT

Aspects of this disclosure pertain to a device with an elongated body having a distal end. The distal end may comprise a port that permits discharge of a laser energy towards a tissue from an optical fiber located in the distal end. An exterior surface of the distal end may include a cauterization portion that permits discharge of a cauterization energy towards the tissue. In some aspects, the device includes an insulative portion that attaches the distal end to the elongated body and limits energy transfer therebetween. Related systems and methods are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application claims the benefit of priority under 35 U.S.C. §119 to U.S. Provisional Patent Application No. 62/192,098, filed Jul.14, 2015, and U.S. Provisional Patent Application No. 62/195,375, filedJul. 22, 2015, the entireties of which are herein incorporated byreference.

TECHNICAL FIELD

Aspects of this disclosure relate to laser devices including, forexample, laser systems, laser bars and laser modules comprising laserdiodes, and methods of using the laser devices. Some aspects relateparticularly to cauterization devices, methods, and systems, such asthose including laser devices.

BACKGROUND

Lasers have been increasingly adopted as medical surgical tools. Opticalfibers have are normally used to deliver laser energy during, forexample, a laser surgery. As compared to traditional surgical tools,laser surgery can reduce bleeding, pain and infection. Additionally,patients often have less hospitalization time after laser surgery.

Laser energy may be less efficient than conventional electrical heatingdevices at stopping bleeding (coagulation), such as bleeding fromincised blood vessels. Therefore, many surgeons will use a laser tool insome procedural steps, and a separate cauterization tool for othersteps. Using multiple tools may complicate certain procedures, such asthose performed in a relatively confined portion of the body, like aninterior portion of a kidney. These complications may increase operatingtime and, thus, the cost of such procedures.

SUMMARY

Aspects of the present disclosure relate to cauterization devices,methods, and systems. Numerous aspects of the present disclosure are nowdescribed.

One aspect of this disclosure is a device with an elongated body havinga distal end. The distal end may comprise: a port that permits dischargeof a laser energy towards a tissue from an optical fiber located in thedistal end; an exterior surface including a cauterization portion thatpermits discharge of a cauterization energy towards the tissue; and aninsulative portion that attaches the distal end to the elongated bodyand limits energy transfer therebetween.

According to this aspect, the port of an exemplary device may beadjacent the cauterization portion. The distal end may have alongitudinal axis, and the port may extend through the cauterizationportion along an axis transverse to the longitudinal axis. Thecauterization portion may comprise the entire exterior surface of thedistal end. In some aspects, the cauterization energy may be anelectrical energy, and the cauterization portion may include anelectrical conductor extending proximally through, for example, theinsulative portion and the elongated body for connection to a source ofelectrical energy. In other instances, the cauterization energy may be athermal energy, and, for example, the laser energy may be dischargedtowards the tissue at a first power level to perform a treatment, andtowards the cauterization portion at a second power level to generatethe thermal energy. The optical fiber may include a first optical fiberthat discharges a first laser energy toward the tissue, and a secondoptical fiber that discharges a second laser energy towards thecauterization portion to generate the thermal energy. These first andsecond laser energies may have different power levels and/orwavelengths.

Another aspect of the present disclosure is a system. An exemplarysystem may comprise: an elongated body including a distal end and atleast one lumen; an optical fiber extending through the at least onelumen for discharge of a laser energy; a port on the distal end fordischarge of the laser energy towards a tissue; a cauterization portionon the distal end for discharge of a cauterization energy toward thetissue; and an insulative portion that attaches the distal end to theelongated body and limits energy transfer therebetween.

According to this aspect, the distal end of the elongated body in anexemplary system may be removably attached to the elongated body. Theport may extend through the cauterization portion. In some aspects, thecauterization energy may be an electrical energy, and the cauterizationportion may include an electrical conductor, which may extend proximallythrough the insulative portion and/or the elongated body for connectionto a source of electrical energy. In other aspects, the cauterizationenergy may be a thermal energy, and the laser energy may bedischargeable towards the cauterization portion to generate the thermalenergy. For example, the optical fiber may be mounted in the elongatedelement for movement between a first position, wherein the laser energyis discharged through the port towards the tissue, to a second position,wherein the laser energy is discharged towards an interior surface ofcauterization portion. The laser energy may be discharged towards thetissue at a first power level, and towards the interior surface of thecauterization portion at a second power level greater than the firstpower level. The laser energy also may be discharged towards the tissueat a first wavelength, and towards the interior surface of thecauterization portion at a second wavelength different from the firstwavelength.

Yet another aspect of the present disclosure is a method. For example,this method may comprise: positioning a distal end of a device adjacenta tissue, the distal end including a port and a cauterization portion;aligning the port with a treatment area of the tissue; discharging alaser energy through the port and towards the treatment area;positioning the cauterization portion adjacent the treatment area; anddischarging a cauterization energy through the cauterization portion andtowards the treatment area.

According to this aspect, the method may further comprise attaching thedistal end to an elongated body of device so as to limit energy transferbetween the distal end and the elongated body. In some aspects, thecauterization energy may be an electrical energy, and discharging thecauterization energy may comprise activing a source of electricalenergy. In other aspects, the cauterization energy may include a thermalenergy, and discharging the cauterization energy may comprisedischarging the laser energy towards the cauterization portion togenerate the thermal energy. The distal end may be attached to theelongated body, and the laser energy may be discharged through anoptical fiber mounted in a lumen of the elongated body. In which case,the method may further comprise: moving the optical fiber to a firstposition in the lumen before discharging the laser energy through theport; and moving the optical fiber to a second position in the lumenbefore discharging the laser energy towards an interior surface of thecauterization portion.

It may be understood that both the foregoing summary and the followingdetailed descriptions are exemplary and explanatory only, neither beingrestrictive of the inventions claimed below.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings are incorporated in and constitute a part ofthis disclosure. These drawings illustrate aspects that, together withthe written descriptions, serve to explain the principles of thisdisclosure.

FIG. 1 is a simplified diagram of an exemplary medical laser system withelectrical cauterization in accordance with aspects of this disclosure.

FIGS. 2A and 2B are simplified side cross-sectional views of a distalend of an exemplary energy delivery device in accordance with aspects ofthis disclosure respectively performing a laser operation and anelectrical cauterization operation.

FIGS. 3A and 3B are simplified side cross-sectional views of a distalend of an exemplary energy delivery device in accordance with aspects ofthis disclosure respectively performing a laser operation and anelectrical cauterization operation.

FIG. 4 is a simplified diagram of an exemplary medical laser system inaccordance with aspects of this disclosure.

FIGS. 5A and 5B are simplified side cross-sectional views of a distalend of an exemplary energy delivery device in accordance with aspects ofthis disclosure respectively performing exemplary laser andcauterization operations.

FIG. 6 is a simplified diagram of an exemplary medical laser system inaccordance with aspects of this disclosure.

FIGS. 7 and 8 are simplified side cross-sectional views of a distal endof an exemplary energy delivery device in accordance with aspects ofthis disclosure respectively performing a laser operation and anelectrical cauterization operation.

FIG. 9 is a simplified side cross-sectional view of a distal end of anexemplary energy delivery device performing a laser operation inaccordance with aspects of this disclosure.

FIG. 10 is a front cross-sectional view of the exemplary energy deliverydevice of FIG. 9 taken generally along line A-A of FIG. 9.

FIG. 11 is a simplified side cross-sectional view of the exemplaryenergy delivery device of FIG. 9 during a cauterization operation.

FIGS. 12 and 13 are simplified side cross-sectional views of exemplaryheating tips in accordance with aspects of this disclosure.

FIGS. 14 and 15 are simplified side cross-sectional views of anexemplary energy delivery device in accordance with aspects of thisdisclosure respectively performing laser and cauterization operations.

FIGS. 16 and 17 are simplified side cross-sectional views of exemplaryenergy delivery devices in accordance with aspects of this disclosure.

FIG. 18 is a front cross-sectional view of the exemplary energy deliverydevice of FIG. 17 taken generally along line B-B of FIG. 17.

DETAILED DESCRIPTION

Aspects of this disclosure are described more fully hereinafter withreference to the accompanying drawings. Elements that are identifiedusing the same or similar reference characters refer to the same orsimilar elements. The various aspects of this disclosure may, however,be embodied in many different forms and should not be construed aslimited to the aspects set forth herein. Rather, these aspects areprovided so that this disclosure will be thorough and complete, and willconvey the scope of this disclosure to those skilled in the art.

Specific details are given in the following description to provide athorough understanding of the aspects. However, it is understood bythose of ordinary skill in the art that the aspects may be practicedwithout these specific details. For example, circuits, systems,networks, processes, frames, supports, connectors, motors, processors,and other components may not be shown, or shown in block diagram form inorder to not obscure the aspects in unnecessary detail.

The terminology used herein is for the purpose of describing particularaspects only and is not intended to be limiting of this disclosure. Asused herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising,” when used in this specification, specify thepresence of stated features, integers, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, integers, steps, operations, elements,components, and/or groups thereof.

It will be understood that when an element is referred to as being“connected” or “coupled” to another element, it can be directlyconnected or coupled to the other element or intervening elements may bepresent. In contrast, if an element is referred to as being “directlyconnected” or “directly coupled” to another element, there are nointervening elements present.

It will be understood that, although the terms first, second, etc. maybe used herein to describe various elements, these elements should notbe limited by these terms. These terms are only used to distinguish oneelement from another. Thus, a first element could be termed a secondelement without departing from the teachings of the present disclosure.

Unless otherwise defined, all terms (including technical and scientificterms) used herein have the same meaning as commonly understood by oneof ordinary skill in the art. It will be further understood that terms,such as those defined in commonly used dictionaries, should beinterpreted as having a meaning that is consistent with their meaning inthe context of the relevant art and will not be interpreted in anidealized or overly formal sense unless expressly so defined herein.

As will further be appreciated by one of skill in the art, the presentdisclosure may be embodied as methods, systems, devices, and/or computerprogram products, for example. Accordingly, the present disclosure maytake the form of an entirely hardware aspect, an entirely softwareaspect or an aspect combining software and hardware aspects. Thecomputer program or software aspect of the present disclosure maycomprise computer readable instructions or code stored in a computerreadable medium or memory. Execution of the program instructions by oneor more processors (e.g., central processing unit) results in the one ormore processors performing one or more functions or method stepsdescribed herein. Any suitable patent subject matter eligible computerreadable media or memory may be utilized including, for example, harddisks, CD-ROMs, optical storage devices, or magnetic storage devices.Such computer readable media or memory do not include transitory wavesor signals.

The computer-usable or computer-readable medium may be, for example butnot limited to, an electronic, magnetic, optical, electromagnetic,infrared, or semiconductor system, apparatus, device, or propagationmedium. More specific examples (a non-exhaustive list) of thecomputer-readable medium would include the following: an electricalconnection having one or more wires, a portable computer diskette, arandom access memory (RAM), a read-only memory (ROM), an erasableprogrammable read-only memory (EPROM or Flash memory), an optical fiber,and a portable compact disc read-only memory (CD-ROM). Note that thecomputer-usable or computer-readable medium could even be paper oranother suitable medium upon which the program is printed, as theprogram can be electronically captured, via, for instance, opticalscanning of the paper or other medium, then compiled, interpreted, orotherwise processed in a suitable manner, if necessary, and then storedin a computer memory.

Aspects of this disclosure may also be described using flowchartillustrations and block diagrams. Although a flowchart may describe theoperations as a sequential process, many of the operations can beperformed in parallel or concurrently. In addition, the order of theoperations may be re-arranged. A process is terminated when itsoperations are completed, but could have additional steps not includedin a figure or described herein.

FIG. 1 is a simplified diagram of an exemplary system 100 configured toperform laser operations and electrical cauterization operations inaccordance with aspects of this disclosure. The system 100 is generallyconfigured to discharge laser energy 102 from a distal end 103 of anenergy delivery device 104 for use in a medical laser operation, such astissue cutting, ablation, vaporization, or other medical laseroperation. Additionally, the system 100 is configured to perform anelectrical cauterization operation at the distal end 103 of the energydelivery device 104.

The energy delivery device 104 may be supported in an endoscope or othersuitable probe. Endoscopes can be used to provide imaging guidance and aflow of cooling liquid, in accordance with conventional practices.

In some aspects, the system 100 includes a laser source 110 and anelectrical cauterization unit 112. The laser source 110 is configured togenerate the laser energy 102 that is optically coupled to the energydelivery device 104 in accordance with conventional techniques. Theelectrical cauterization unit 112 is configured to generate electricalenergy in the form of an electrical current that is coupled to theenergy delivery device 104 through one or more electrical conductors.

In some aspects, the system 100 includes one or more input devices 114that are used by the operator of the system 100 to control the deliveryof the laser energy 102 and the electrical energy through the energydelivery device 104. In some aspects, the input device 114 includes atleast one switch 116 for operating the laser source 110, and at leastone switch 118 for operating the electrical cauterization unit 112. Insome aspects, the switches 116 and 118 may be implemented using footpedals, buttons, or other suitable input devices.

In some aspects, the laser source 110 and the electrical cauterizationunit 112 are each standalone units. In some aspects, the laser source110 and the electrical cauterization unit 112 are integrated into asingle console, as illustrated in FIG. 1.

FIGS. 2A and 2B are simplified side cross-sectional views of the distalend 103 of an exemplary energy delivery device 104 in accordance withaspects of this disclosure respectfully performing a laser operation andan electrical cauterization operation on tissue 120. FIGS. 3A and 3B aresimplified side cross-sectional views of the distal end 103 of anexemplary energy delivery device 1104 in accordance with aspects of thisdisclosure respectfully performing a laser operation and an electricalcauterization operation on tissue 120. In some aspects, the energydelivery device 104 includes an optical or laser fiber 122 that isconfigured to receive the laser energy 102 generated by the laser source110 and transmit the laser energy 102 to the distal end 103 where it isdischarged for performing the desired laser operation, as shown in FIGS.2A and 3A. The optical or laser fiber 122 may take on variousconventional forms. For example, the laser fiber 122 may have aside-fire configuration, in which a terminating end 124 has a beveledsurface configured to reflect the laser energy 102 laterally relative toa longitudinal axis 126 and discharge the laser energy 102 through aside port 128 of the device 104 to the targeted tissue 120, as shown inFIGS. 2A and 3A. Alternatively, the laser fiber 122 may be configured todischarge the laser energy 102 along the longitudinal axis 126 of thelaser fiber 122 at the terminating end and through a suitable port ofthe device 104 (end-fire configuration).

The electrical cauterization function of the energy delivery devices 104and 1104 can be realized in a monopolar form or a bipolar form. Ingeneral, the energy delivery devices 104 and 1104 respectively includeat least a first electrical conductor 132, 1132, which can be in theform of a metal wire, that receives electrical energy from theelectrical cauterization unit 112 and delivers the electrical energy inthe form of an electrical current to a cauterization portion 130 at thedistal end 103 of the energy delivery devices 104 and 1104. In someaspects, the cauterization portion 130 includes an electricallyconductive portion or element 134 (FIGS. 2A and 2B) or 1134 (FIGS. 3Aand 3B) that is supported at the distal end 103. In some aspects, theportions 134 and 1134 are in the form of a metal cap, as shown in FIGS.2A and 3A. In some aspects, the electrically conductive portion 134 or1134 includes the port 128, through which the laser energy 102 may bedischarged, as shown in FIGS. 2A and 3A. In some aspects, thecauterization portion 130 includes an electrically insulative portion136 (FIG. 2A) or 1136 (FIG. 3A) located toward the proximal end of thedevice 104 from the electrically conductive portion 134 or 1134,respectively. The electrically insulative portion 136 or 1136 operatesto insulate the electrically conductive portion 134 or 1134 fromcomponents of the energy delivery device 104 or 1104, other than theconductor 132. In some aspects, the electrically insulative portion 136or 1136 is formed of a polymer or ceramic material.

Depicted in FIGS. 2A and 2B is a monopolar aspect of this disclosure. Inthis aspect, the energy delivery device 104 includes a laser fiber 122having a longitudinal axis 126, a cauterization portion 130 included ona distal portion of the laser fiber 122 and having an electricallyconductive portion 134 and a side port 128, an electrical conductor 132and an electrically insulative portion 136. As can be seen in FIGS. 2Aand 2B, the electrical conductor 132 connects to the cauterizationportion 130 through the electrically insulative portion 136. In thismonopolar aspect, a return pad 137 may be necessary to complete theelectric circuit allowing current 139 to flow from the cauterizationportion 130, through the tissue 120 and into the return pad 137 therebycauterizing the tissue 120, as depicted in FIG. 2B.

In some aspects, as depicted in FIGS. 3A and 3B, the delivery device1104 has a bipolar configuration, and includes a first electricallyconductive element 1134 that is electrically coupled to a firstelectrical conductor 1132. In addition, the delivery device 1104includes a second electrically conductive element 1138 that iselectrically coupled to a second electrical conductor 1140. The firstand second electrical conductors can be, for example, metal wire. Inorder to isolate the first electrically conductive element 1134 from thesecond electrically conductive element 1138, an electrically insulative,non-conductive material 1136 is included between the first electricallyconductive element 1134 from the second electrically conductive element1138. The non-conductive material 1136 can be, for example, a polymericor ceramic material.

In use, electrical current 1141 delivered to the tissue 1120 through thefirst electrical conductor 1132, to the first electrically conductiveelement 1134, through the tissue 120, into the second electricallyconductive element 1138, to the second electrical conductor 1140 andthen back to the electrical cauterization unit 112. In some aspects, thefirst electrically conductive element 1134 is in the form of a cap thatis glued or crimped to the electrically insulative portion 1136 or othercomponent of the energy delivery device 1104.

During a laser operation, laser energy 102 is generated by the lasersource 110 and delivered to a proximal end of the optical fiber 122. Thelaser energy is delivered through the optical fiber 122 to the distalend 103 of the energy delivery device 104 where it is discharged towardthe targeted tissue 120 of the patient. The laser energy 102 may bedischarged laterally (side-fire configuration) through a port 128 to thetissue 120, as shown in FIGS. 2A, 2B, 3A and 3B. Alternatively, theterminating distal end of the fiber 122 may be configured to dischargethe laser energy 102 along the axis 126 of the fiber to the targetedtissue, as indicated in phantom lines in FIG. 1. The generation of thelaser energy 102 by the laser source 110 may be controlled through asuitable input device 114 by the user of the system 100.

An electrical cauterization operation can be performed by enabling theelectrical cauterization unit 112 to produce electrical energy, which isdelivered to the distal end 103 of the energy delivery device 104, 1104through the first electrical conductor 132, 1132. The generation of theelectrical energy may be triggered using a suitable input device 114 bythe user. The electrical energy in the form of an electrical current isconducted to the targeted tissue 120 through the electrically conductiveportion 134 or first electrically conductive element 1134. In themonopolar aspect of FIGS. 2A and 2B, a return path for the electricalcurrent 139 to the electrical cauterization unit 112 may be providedthrough the return pad 137 that is attached to the patient. In thebipolar aspect of FIGS. 3A and 3B, the electrical current 1141 may bereturned to the electrical cauterization unit 112 through the secondelectrically conductive element 1138 and the second electrical conductor1140. The delivery of the electrical current to the tissue 120 of thepatient generates heat that cauterizes the tissue 120 to stop bleeding.

In general, such an electrical cauterization operation is performedafter a laser operation in order to control bleeding in the patient. Theinput device 114 allows the user to quickly switch between the laseroperation and the electrical cauterization operation as needed.

FIG. 4 is a simplified diagram of an exemplary system 150 that isconfigured to perform laser and cauterization operations according toanother aspect of this disclosure. In some aspects, the cauterizationoperations are performed by conducting laser-generated heat to thetargeted tissue.

In some aspects, the system 150 includes a laser source 152 and anenergy delivery device 154. In some aspects, the laser source 152includes a discharge laser source 156 and a cauterization laser source158. The discharge laser source 156 is configured to generate laserenergy 160 that is optically coupled to a discharge laser fiber 162. Thedischarge laser fiber 162 transmits the laser energy 160 to a dischargetip 164, which discharges the laser energy 160 toward targeted tissue182 during a laser operation in order to perform a laser treatment suchas, for example, vaporization, etc.

The cauterization laser source 158 is configured to generate laserenergy 166 that is optically coupled to a cauterization laser fiber 168.The cauterization laser fiber 168 is configured to discharge the laserenergy 166 to a cauterization tip 170 to heat the cauterization tip 170and perform a cauterization operation (see FIG. 5B). In general, thecauterization tip 170, heated in response to exposure to the laserenergy 166, is placed in contact with targeted tissue 182 to heat andcauterize the tissue to stop bleeding.

In some aspects, the system 150 includes at least one input device 172to control the discharge laser source 156 and the cauterization lasersource 158. In some aspects, the input device 172 includes a switch 174for activating and deactivating the discharge laser source 156, and aswitch 176 for activating and deactivating the cauterization lasersource 158. In some aspects, the switches 174 and 176 are in the form offoot pedals or other suitable input devices.

FIGS. 5A and 5B are simplified side cross-sectional views of a distalend 180 of an exemplary energy delivery device 154 in accordance withaspects of this disclosure performing an exemplary laser operation (FIG.5A) and cauterization operation (FIG. 5B). In some aspects, thedischarge laser fiber 162 has a proximal end that receives the laserenergy 160 generated by the discharge laser source 156. The laser energy160 is transmitted through the fiber 162 to the discharge tip 164 whereit is discharged toward targeted tissue 182, as shown in FIG. 5A. Thedischarge laser fiber 162 may be formed in accordance with the aspectsof the laser fiber 122 described above with regard to FIGS. 2 and 3. Forexample, the discharge laser fiber 162 may be configured to dischargethe laser energy 160 laterally relative to a longitudinal axis 126 ofthe discharge laser fiber 162 (side-fire configuration), or thedischarge laser fiber 162 may be configured to discharge the laserenergy 160 along the longitudinal axis 126 (end-fire configuration). Thedischarge laser fiber 162 may also be configured to discharge the laserenergy 160 in accordance with other conventional techniques. Ifnecessary, the discharge laser energy 160 may be discharged through aport of the energy delivery device 154, such as port 128 shown in FIGS.5A and 5B.

In some aspects, the energy delivery device 154 includes thecauterization laser fiber 168 that receives the laser energy 166generated by the cauterization laser source 158 and delivers thecauterization laser energy 166 to the cauterization tip 170. In someaspects, the cauterization tip 170 includes a thermally conductiveelement formed of a material that absorbs the cauterization laser energy166 and is positioned to receive the cauterization laser energy 166discharged from the cauterization laser fiber 168, as shown in FIG. 5B.In some aspects, the cauterization tip 170 is in the form of a metal capthat is secured (e.g., crimped, glued, etc.) to the discharge laserfiber 162, the cauterization laser fiber 168, and/or other components ofthe energy delivery device 154, as shown in FIGS. 5A and 5B.

In some aspects, the distal end of the cauterization laser fiber 168through which the cauterization laser energy 166 is discharged issufficiently spaced from the cauterization tip 170 to avoid damage dueto the discharge of the laser energy 166 and the associated heating ofthe cauterization tip 170 responsive to the exposure to thecauterization laser energy 166. In some aspects, the energy deliverydevice 154 includes an insulative element 184 located on the proximalside of the cauterization tip 170 that is configured to insulateelements of the energy delivery device 154 from the heat generated atthe distal end 180 due to the discharge of the cauterization laserenergy 166. In some aspects, the insulative element 184 extends distallyas illustrated in FIG. 5A to thermally insulate the cauterization laserfiber 168 and the discharge tip 164 from heat generated responsive tothe discharge of the cauterization laser energy 166 from thecauterization laser fiber 168. In some aspects, the cauterization tip170 is attached directly to the insulative element 182.

During a laser operation/treatment, a user triggers activation of thedischarge laser source 156, such as by using the input device 172, togenerate the discharge laser energy 160. The laser energy 160 isoptically coupled to the discharge laser fiber 162, which delivers thelaser energy 160 to the discharge tip 164 where it is discharged totargeted tissue 182 to perform the desired laser operation on the tissue182. When the user wishes to cauterize tissue of the patient, such asdue to bleeding after the performance of the laser operation, thedischarge laser source 156 is deactivated, and the cauterization lasersource 158 is activated by the user, such as through the input device172. The cauterization laser energy 166 generated by the cauterizationlaser source 158 is delivered to the cauterization tip 170 through thecauterization laser fiber 168. Exposure of the cauterization tip 170 tothe cauterization laser energy 166 quickly heats the cauterization tip170. The tip 170 can then be brought into contact with the targetedtissue 182 to cauterize the tissue 182, as shown in FIG. 5B.

In some aspects, the laser energy 160 generated by the discharge lasersource 156 includes relatively high power laser energy that is usefulfor tissue cutting, ablation, vaporization, or other medical laseroperations/treatments. In some aspects, the laser energy 166 generatedby the cauterization laser source 158 has a relatively low powercompared to the laser energy 160, such as less than 10 watts. In someaspects, the cauterization tip 170 is heated to around 60-80° C. toperform the cauterization operation.

In some aspects, the wavelengths of the discharge laser energy 160 andthe cauterization laser energy 166 are the same. In some aspects, thewavelengths of the discharge laser energy 160 and the cauterizationlaser energy 166 are different. For example, the wavelengths of thelaser energy 160 and 166 may be the same but at different power levels.Furthermore, while the discharge laser energy 160 is selected toefficiently perform the desired laser operation, the cauterization laserenergy 166 may be selected to efficiently heat the cauterization tip170. Thus, in some aspects, the cauterization laser energy 166 has awavelength that is adapted to efficiently heat the cauterization tip170. Other factors for determining the wavelength and power levels ofthe laser energies 160 and 166 include the diameter of the dischargelaser fiber 162 and the cauterization laser fiber 168, and the laserbeam output quality from the laser sources 156 and 158, for example.

In some aspects, a single laser source is used to produce both thedischarge laser energy 160 and the cauterization laser energy 166. Inaccordance with this aspect, suitable optics are used to selectivelycouple the laser energy outputs from the single laser source to eitherthe discharge laser fiber 162 or the cauterization laser fiber 168. Thesettings of the single laser source may be adjusted to provide thedesired energy/power levels and/or wavelengths of the laser energies 160and 166.

FIG. 6 is a simplified diagram of an exemplary medical laser system 190in accordance with aspects of this disclosure. In some aspects, thesystem 190 includes a laser source 192 and an energy delivery device194. In some aspects, the laser source 192 is configured to producelaser energy 196 for use in performing a medical laser operation, suchas those described above. The laser source 192 may be configured tooutput the laser energy 196 at different wavelengths and power levels.In some aspects, the system 190 includes one or more input devices 198,through which a user controls the activation of the laser source 192 togenerate the laser energy 196, adjust settings of the laser source 192to control the wavelength and/or power level of the laser energy 196,and/or perform other functions. The input devices can be any of thosepreviously disclosed and described.

In some aspects, the energy delivery device 194 includes a laser fiber200 that is optically coupled to the laser energy 196 generated by thelaser source 192. The laser fiber 200 is configured to discharge thelaser energy 196 in a desired direction, such as laterally with respectto a longitudinal axis of the laser fiber 200 (side-fire configuration),or along the longitudinal axis of the laser fiber (end-fireconfiguration). In some aspects, the energy delivery device 194 isconfigured to perform a laser operation by directing the laser energy196 toward targeted tissue of a patient. In some aspects, the energydelivery device 194 is configured to direct the laser energy 196discharged from the laser fiber 200 to a cauterization tip 202. Theexposure of the cauterization tip 202 to the laser energy 196 heats thecauterization tip 202, which can be used to perform a cauterizationoperation on the patient. In some aspects, the laser fiber 200 is movedrelative to the cauterization tip 202 to expose the cauterization tip202 to the laser energy 196. The laser fiber 200 may then be moved againrelative to the cauterization tip 202 to discharge the laser energy 196toward the targeted tissue to perform a laser operation on the tissue.In other aspects, the cauterization tip 202 is moved relative to thelaser fiber 200 to switch between discharging laser energy 196 totargeted tissue and discharging laser energy 196 to the cauterizationtip 202 to perform cauterization on targeted tissue.

FIGS. 7 and 8 are simplified side cross-sectional views of a distal end206 of an energy delivery device 194A in accordance with the aspects ofthis disclosure, respectively performing laser and cauterizationoperations. In some aspects, the energy delivery device 194A includes anendoscope 208, a distal end of which is shown in FIGS. 7 and 8. In someaspects, the endoscope 208 is used to deliver the laser fiber 200 andcauterization tip 202 to a desired treatment location to perform laserand cauterization operations on the patient.

As mentioned above, aspects of the laser fiber 200 include an end-fireconfiguration in which the laser energy 196 is discharged from theterminating end of the laser fiber 200 along the longitudinal axis 210of the laser fiber 200. In some aspects, the laser fiber 200 isconfigured as a side-fire laser fiber, in which the laser energy 196 isdischarged laterally with respect to the longitudinal axis 210, as shownin FIGS. 7 and 8. In some aspects, in order to discharge the laserenergy 196 laterally, as depicted in FIGS. 7 and 8, the laser fiber 200includes an optical fiber 212 having a terminating end 214 that includesa beveled surface 216. A fiber cap 218 covers the terminating end 214and seals an air cavity 220 adjacent the beveled surface 216. Thisconfiguration causes the laser energy 196 transmitted through theoptical fiber 212 to reflect off the beveled surface 216 laterallyrelative to the longitudinal axis 210 toward targeted tissue 222 toperform a laser operation on the tissue 222, as shown in FIG. 7. Such alaser fiber may also be used with other aspects described herein.

In some aspects, the energy delivery device 194A supports the laserfiber 200 within a lumen 224 of a member 226 that supports thecauterization tip 202. In some aspects, the cauterization tip 202 isformed of a thermally conductive material, such as metal, that isattached to the member 226. In some aspects, a thermally insulativeportion 228 is positioned between the member 226 and the cauterizationtip 202 to reduce the conduction of heat from the cauterization tip 202to the member 226.

As can be seen in FIGS. 7 and 8, the cauterization tip 202 includes anopening or side port 227 therein to allow laser energy 196 to bedischarged through the cauterization tip 202. During a laser treatmentoperation such as, for example, vaporization, the cauterization tip 202is positioned over the laser fiber 200 such that the side port 227aligns with the discharge path of the laser energy 196 as depicted inFIG. 7.

In some aspects, when cauterization is desired, a cauterizationoperation may be performed by moving the laser fiber 200 relative to themember 226 and the supported cauterization tip 202 to position the laserfiber 200 adjacent the cauterization tip 202, as shown in FIG. 8. Thatis, the laser fiber 200 is positioned within the member 226 andcauterization tip 202 such that the side port 227 no longer aligns withthe discharge path of the laser energy 196 (FIG. 8). The laser source192 is then activated to discharge the laser energy 196 to thecauterization tip 202. The cauterization tip 202 is heated in responseto this exposure to the laser energy 196. The user of the energydelivery device 194 may then place the heated cauterization tip 202 incontact with the targeted tissue 222 to cauterize the tissue 222, asshown in FIG. 8.

FIGS. 9-11 illustrate an energy delivery device 194B in accordance withadditional exemplary aspects of this disclosure, which can be used withthe system depicted in FIG. 6. For example, FIG. 9 is a simplified sidecross-sectional view of the distal end 306 of an exemplary energydelivery device 194B performing a laser operation in accordance withaspects of this disclosure. As a further example, FIG. 10 is a frontcross-sectional view of the exemplary energy delivery device 194B ofFIG. 9 taken generally along the line A-A of FIG. 9. As yet anotherexample, FIG. 11 is simplified side cross-sectional view of theexemplary energy delivery device 194B during a cauterization operation.

In some aspects, the energy delivery device 194B utilizes an endoscope308 to support the laser fiber 200 and the cauterization member 302. Thecauterization member 302 includes a thermally conductive portion 327 atits distal end. In some aspects, both the laser fiber 200 andcauterization member 302 are configured to move relative to each otherand the endoscope 308, such as sliding by hand or other conventionaltechniques.

During a laser operation, the laser fiber 200 is extended through thedistal end of the endoscope 308, as shown in FIG. 9. The laser source192 (FIG. 6) is activated to deliver laser energy 196 through the laserfiber 200 and discharge the laser energy 196 to the targeted tissue 322.The laser operation (such as vaporization) is performed on the tissue322 in response to the exposure to the laser energy 196. In someaspects, the cauterization member 302 is recessed within the endoscope308 during the laser operation, as shown in FIG. 9.

In some aspects, the cauterization operation is performed by advancingthe cauterization member 302 through the distal end of the endoscope308, as shown in FIG. 11. In some aspects, the thermally conductiveportion 327 of the cauterization member 302 is positioned adjacent theemission surface of the laser fiber 200 or discharge path of the laserenergy 196. Thus, when the user activates the laser source 192, thelaser energy 196 is transmitted through the laser fiber 200 anddischarged into the thermally conductive portion 327 of thecauterization member 302. The thermally conductive portion 327 is heatedin response to exposure to the laser energy 196. Cauterization isperformed by placing the now heated conductive portion 327 in contactwith the targeted tissue 322, as shown in FIG. 11. In some aspects, thecauterization member 302 includes a thermally insulative portion 328that protects the endoscope 308 and/or portions of the laser fiber 200from excessive heat generated during the cauterization operation.

FIGS. 12 and 13 are simplified side cross-sectional views of exemplarycauterization members 402 in accordance with aspects of this disclosure.In some aspects, the thermally conductive portion 427 of thecauterization member 402 has a blunt shape, as shown in FIG. 12. In someaspects, the thermally conductive portion 427 has a concave shape, suchas a half loop, in order to capture the laser energy 196, as shown inFIG. 13. The shape of the thermally conductive portion 427 can be anyshape and can be selected based on the type of cauterization operationanticipated to be performed. The shape may affect the efficiency of thecauterization operation.

FIGS. 14 and 15 are simplified cross-sectional views of an exemplaryenergy delivery device 194C in accordance with aspects of thisdisclosure respectfully performing a laser operation and a cauterizationoperation. In some aspects, the cauterization member 502 is mounted tothe distal end of the endoscope 508. In some aspects, the endoscope 508is protected from the heat generated during the cauterization operationby insulating the endoscope 508 from the thermally conductive portion527 with a thermally insulative portion 528.

During a laser operation, the laser fiber 200 is extended through thedistal end 506 of the endoscope 508 and past the cauterization member502 such that the laser energy 196 discharged from the laser fiber 200is directed at the targeted tissue 522, as shown in FIG. 14.

To perform a cauterization operation, the laser fiber 200 is retractedinto the endoscope 508 such that the laser energy 196 discharged fromthe laser fiber 200 is directed into the thermally conductive portion527 of the cauterization member 502. The exposure of the thermallyconductive portion 527 to the laser energy 196 heats the thermallyconductive portion 527. The user can then place the heated thermallyconductive portion 527 into contact with the targeted tissue 522 toperform cauterization on the tissue 522, as shown in FIG. 15. In someaspects, the cauterization member 502 is cylindrically shaped andsurrounds the laser fiber 200. This simplifies the cauterizationoperation by ensuring that the thermally conductive portion 527 isexposed to the laser energy 196 when the laser fiber 200 is at a knownposition relative to the endoscope 508 regardless of the angularposition of the laser fiber 202 about its longitudinal axis 210, asshown in FIG. 15.

In some aspects, the cauterization member 602 is in the form of anadd-on device that can be removably attached to the distal end 506 ofthe endoscope 508. The attachment of the cauterization member 502 can beaccomplished using any suitable technique. Thus, following a laseroperation, the user can attach the cauterization member 502 to theendoscope 508 to perform a cauterization operation.

In some aspects, the cauterization member 502 includes a sleeve portion540 that attaches to the distal end 506 of the endoscope 508, as shownin the simplified side cross-sectional views of exemplary energydelivery devices 194D and 194E shown in FIGS. 16 and 17. In someaspects, the sleeve portion 540 includes a thermally insulative portion528 to prevent overheating of the endoscope 508. The sleeve portion 540may be attached to the distal end of the endoscope 508 in many differentways. In some aspects, the sleeve portion 540 forms a socket thatreceives the distal end of the endoscope 508, as shown in FIGS. 16 and17.

In some aspects, the thermally conductive portion 527 of thecauterization member 502 covers the distal end of the laser fiber 200and is configured to be exposed to laser energy 196 discharged along thelongitudinal axis 210 of the laser fiber 200, as indicated by thephantom arrow 196 shown in FIG. 16. In some aspects, the distal end ofthe laser fiber 200 is configured to discharge laser energy 196laterally with respect the longitudinal axis 210 of the laser fiber 200,as indicated in FIG. 17. In some aspects, the detachable cauterizationmember 502 has an open distal end, which allows laser operations to beperformed by the laser fiber 200 by extending the laser fiber 200 beyondthe open distal end of the cauterization member 502, as discussed abovewith respect to FIG. 14. In some aspects, the thermally conductiveportion 527 surrounds the laser fiber 200, as shown in FIG. 18, which isa simplified front cross-sectional view of the energy delivery device194E of FIG. 17 taken generally along line B-B.

In some aspects disclosed herein, it is important to monitor and controlthe temperature of the cauterization portion/tip/member of the energydelivery device in order to (1) prevent overheating of tissue, which canresult in carbonization and (2) prevent damage to the cauterizationportion/tip/member. Monitoring and measuring of the cauterizationportion/tip/member can be achieved by detecting, collecting and/oranalyzing the black body radiation or electromagnetic energy feedbackproduced at the cauterization portion/tip/member. This black bodyradiation or electromagnetic energy feedback can be used to control thelaser power/energy to ensure that the cauterization portion/tip/membertemperature remains at a safe level, for example, between 60-100 degreesCelsius. Methods and devices for detecting, collecting and/or analyzingthe black body radiation or electromagnetic energy feedback produced atthe cauterization portion/tip/member are described and disclosed incommonly-assigned International Patent Application No. PCT/US2014/61319,filed on Oct. 20, 2014, the entire contents of which are incorporatedherein by reference in their entirety for all purposes.

In alternative aspects of the present disclosure, the cauterizationportion/tip/member temperature can be controlled by a flowing irrigant.Irrigation flow can be achieved and controlled using the devicesdescribed and disclosed in commonly assigned U.S. Pat. Nos. 7,869,016and 8,858,542, and commonly assigned U.S. patent application Ser. No.14/471,945, filed on Aug. 28, 2014. The entire contents of U.S. Pat.Nos. 7,869,016 and 8,858,542, and U.S. patent application Ser. No.14/471,945 are incorporated herein by reference in their entirety forall purposes. Additionally, irrigation can be provided to thecauterization portion/tip/member with an endoscope, cystoscope or othersimilar device.

Although the present disclosure has been described with reference toillustrative aspects for particular applications, the disclosure is notlimited thereto. Those have ordinary skilled in the art and access tothe teachings provided herein will recognize that additionalmodifications, applications, aspects, changes, and substitution ofequivalents all fall in the scope of this disclosure, and may be made inform and detail without departing from the spirit and scope of thisdisclosure. Accordingly, the present disclosure is not to be consideredas limited by the foregoing description.

What is claimed is:
 1. A device with a body having at least one lumen,an optical fiber extending through the at least one lumen for dischargeof a laser energy, and a distal end, the distal end comprising: a portthat permits discharge of the laser energy towards a tissue from theoptical fiber located in the distal end; an exterior surface including acauterization portion that permits discharge of a cauterization energytowards the tissue; and an insulative portion that attaches the distalend to the body and limits energy transfer therebetween; wherein thecauterization energy is a thermal energy, and the laser energy isdischargeable towards the cauterization portion to generate the thermalenergy; and wherein the optical fiber is mounted in the body formovement between a first position, wherein the laser energy isdischarged through the port towards the tissue, to a second position,wherein the laser energy is discharged towards an interior surface ofcauterization portion.
 2. The device of claim 1, wherein the port isadjacent the cauterization portion.
 3. The device of claim 1, whereinthe distal end has a longitudinal axis, and the port extends through thecauterization portion along an axis transverse to the longitudinal axis.4. The device of claim 1, wherein the cauterization portion comprisesthe entire exterior surface of the distal end.
 5. The device of claim 1,wherein the laser energy is discharged towards the tissue at a firstpower level to perform a treatment, and towards the cauterizationportion at a second power level to generate the thermal energy.
 6. Thedevice of claim 5, wherein the optical fiber includes a first opticalfiber that discharges a first laser energy toward the tissue, and asecond optical fiber that discharges a second laser energy towards thecauterization portion to generate the thermal energy, the first andsecond laser energies having different wavelengths.
 7. A systemcomprising: a body including a distal end and at least one lumen; anoptical fiber extending through the at least one lumen for discharge ofa laser energy; a port on the distal end for discharge of the laserenergy towards a tissue; a cauterization portion on the distal end fordischarge of a cauterization energy toward the tissue; and an insulativeportion that attaches the distal end to the body and limits energytransfer therebetween; wherein the cauterization energy is a thermalenergy, and the laser energy is dischargeable towards the cauterizationportion to generate the thermal energy; and wherein the optical fiber ismounted in the body for movement between a first position, wherein thelaser energy is discharged through the port towards the tissue, to asecond position, wherein the laser energy is discharged towards aninterior surface of cauterization portion.
 8. The device of claim 7,wherein the distal end is removably attached to the body.
 9. The deviceof claim 8, wherein the port extends through the cauterization portion.10. The system of claim 7, wherein the laser energy is dischargedtowards the tissue at a first power level, and towards the interiorsurface of the cauterization portion at a second power level greaterthan the first power level.
 11. The system of claim 7, wherein the laserenergy is discharged towards the tissue at a first wavelength, andtowards the interior surface of the cauterization portion at a secondwavelength different from the first wavelength.
 12. A method comprising:positioning a distal end of a device adjacent a tissue, the distal endincluding a port and a cauterization portion and being attached to abody of the device; aligning the port with a treatment area of thetissue; discharging a laser energy through the port and towards thetreatment area; positioning the cauterization portion adjacent thetreatment area; discharging a cauterization energy through thecauterization portion and towards the treatment area, wherein thecauterization energy includes a thermal energy, and discharging thecauterization energy comprises discharging the laser energy towards thecauterization portion to generate the thermal energy, wherein the laserenergy is discharged through an optical fiber mounted in a lumen of thebody of the device; moving the optical fiber to a first position in thelumen before discharging the laser energy through the port; and movingthe optical fiber to a second position in the lumen before dischargingthe laser energy towards an interior surface of the cauterizationportion.
 13. The method of claim 12, further comprising attaching thedistal end to the body of the device so as to limit energy transferbetween the distal end and the body of the device.
 14. The method ofclaim 12, wherein the cauterization energy is an electrical energy, anddischarging the cauterization energy comprises activing a source ofelectrical energy.